The Importance of Medical Illustration in Patient Communication

For Dr. Francois Luks, the pen is mightier than the sword. Armed with ink and a blank pad of paper, he begins to draw out a stomach. With a stroke here and some shading there, he deftly sketches the anastomoses of a procedural resection. A few moments later, he shows me his work of art — a visual explanation of a surgery he had done. This is just a sampling of what he does for patients in the clinic. He uses his passion for art to enhance patient communication.

Dr. Luks wears many hats. As the pediatric surgeon-in-chief at Hasbro Children’s Hospital in Rhode Island, he not only spends time on research, mentorship and clinical practice, but he also leads an undergraduate course at Brown University called “Physician as Illustrator.” Although it was first approved in the summer of 2017, the course’s beginnings stem back to several years earlier. Dr. Luks had led a two-hour session on medical illustration for a small preclinical elective at The Warren Alpert Medical School of Brown University. That two-hour session evolved into its own semester-long preclinical elective. Now that elective has transformed into its first year as a full-fledged course, not only for medical students but for undergraduates too at both Brown University and at the Rhode Island School of Design (RISD), a premier art school nearby.

When did he first realize his passion for art? He harkens to his childhood.

“Ever since I was a toddler, I was always drawing,” Dr. Luks explains. As he grew older, he began drawing a daily comic for a local newspaper. His passion continued in medical school, when he drew medical illustrations for research publications. Born and raised in Belgium, he later completed a general surgery residency in New York, then a pediatric surgery residency in Montreal. After a research fellowship, he came to Providence, Rhode Island to join Hasbro Children’s Hospital in the 1990s. Before the dawn of the electronic health record, he would include drawings of his surgical procedures within patients’ paper documents. He recognized the power of art.

Illustration is valuable in patient communication. Medical terminology can be complex and sometimes confusing. “There are big words in medicine,” Dr. Luks says, “but a drawing stays.” Visuals can speak louder than words. When he interacts with patients whose primary language is not English, Dr. Luks employs sketches to try to communicate as best he can. If the procedure, treatment, illness or diagnosis is difficult to comprehend, he uses illustration as part of his clinical repertoire.

Dr. Luks recounts a story of how one of his drawings significantly impacted a patient. The case was a medical emergency — a transected pancreas that needed to be treated quickly and effectively. Understandably, the patient and his family were very concerned and anxious. Dr. Luks tried to assuage their fears. He took the time to explain the surgery, drawing out the pancreas and showing them what would happen. Post-surgery, the patient’s family thanked Dr. Luks because they said the illustration helped them better understand what their son would undergo and gave them the reassurance they needed. The drawing is still with this patient to this day.

Medical illustration is also important when communicating with other members of the health care team. “A lot of us draw,” he emphasizes, “and it doesn’t really matter how good or bad it is.” One of his colleagues is a burn surgeon who draws out very basic outlines of the hand to show where burns are. Not only surgeons, but also radiologists, pediatricians, gastroenterologists and many other of his colleagues draw medical sketches no matter how rudimentary the drawing may be.

Nevertheless, Dr. Luks does encourage students and providers to embrace the value of illustration in medicine. “It’s like being a good conductor,” he offers. The conductor knows the next steps and guides the orchestra, improvising if any issue arises. So, too, does using sketches in medicine (especially in the field of surgery) involve knowing the next steps, guiding the health team and learning how to navigate challenges if they arise. Drawing also establishes understanding. To draw a procedure or an organ, the person needs to understand what they are drawing as best they can. Sketching can help tease out and wrestle their thoughts onto one place, as if thinking out loud on paper.

Illustration also plays a significant role in medical education. A clear and concise visual can teach medical students so much about anatomy. Ian Suk, B.Sc., B.M.C., a lauded medical illustrator, recently came to Brown University to give a guest lecture as part of the “Physician as Illustrator” course. At Johns Hopkins University, he holds a joint appointment in the Department of Neurosurgery and in the Department of Art as Applied to Medicine. Combining his passions, he illustrates neurosurgical procedures and clinical anatomy — from tumors of the spine to various brain tumor procedures. He echoed how a good illustration goes a long way in education. Perhaps the most famous medical illustrator is Dr. Frank H. Netter, a physician whose works of art have become integrated in many medical schools’ curricula. His portrayals of symptoms using life-like examples of everyday people and situations have often been compared to that of Norman Rockwell.

For those who may be wary of their artistic capabilities, Dr. Luks encourages medical students to see the value of art in medicine, emphasizing how illustration improves communication with patients and health care providers. He wants students to not be intimidated if art isn’t their strength. “Anyone can draw,” he affirms. People may have different skill sets, but drawing even basic sketches can help us become a better physician and a better communicator with our patients.

Ollin Venegas, a second-year medical student at Brown, took the preclinical elective last year. He emphasized how learning a basic algorithm of shape, contours and shading is fundamental to creating an alternative means of communication between patients and providers. “If a picture is worth a thousand words,” he adds, “a well-drawn medical illustration for a patient…is worth triple that!”

Jazmin Aceves, a first-year student at Brown in the Program in Liberal Medical Education (PLME), joined the piloted undergraduate course this past fall, which she described as “incredibly engaging and hands-on.” From anatomical material to the practice of artistic techniques, the class sessions focused on encouraging and enhancing one’s abilities in illustration and communication. Likewise, Sabrina Arezo, a first-year PLME student who also took the course, said her biggest takeaways included learning drawing techniques to demonstrate and explain medical procedures. She hopes to use the techniques she learned in this class “with my own patients in the future.”

For medical students who are already rotating in the hospitals, they are applying what they learned in class to their clinical encounters. Third-year medical student Alice Cao, who also served as one of the student leaders for the course, emphasizes how medical illustration focuses on communication in a medically accurate and understandable way. “From sketching a gallbladder to explain a cholecystectomy to drawing the anatomy of a breast duct to explain metastasis,” Alice offers, “I have carried a piece of this class with me everywhere during my third year clerkships.”

Collaborating with RISD has sparked an interdisciplinary exchange of knowledge and ideas. Dr. Luks desires the course to keep growing and flourishing. His ultimate goal is to develop a true program in medical illustration leading to an accredited degree. “Currently, there are only four such programs in North America,” he remarks. Despite the low number of programs currently, he is hopeful for a cultural shift. Dr. Luks foresees medical illustration playing a larger role in medical education. At the end of the day, we go into medicine to serve patients. And if drawings, sketches and visuals can help patients better understand their diagnosis, a procedure or any facet of their medical care, it is worth exploring the crossroads of art and medicine.

Born in Cincinnati, Ohio, Anna Delamerced is a 2nd-year medical student at Brown University, with a background in Public Health and creative writing. As she continues on this journey, she is grateful to learn from teachers and fellow classmates. If you have a story to share, she'd love to hear from you.

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